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Changes in eicosapentaenoic acid and docosahexaenoic acid and risk of cardiovascular events and atrial fibrillation: A secondary analysis of the OMEMI trial

Journal of internal medicine, 2022-05, Vol.291 (5), p.637 [Peer Reviewed Journal]

2021 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine. ;info:eu-repo/semantics/openAccess ;ISSN: 0954-6820 ;EISSN: 1365-2796 ;DOI: 10.1111/joim.13442 ;PMID: 34982486

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  • Title:
    Changes in eicosapentaenoic acid and docosahexaenoic acid and risk of cardiovascular events and atrial fibrillation: A secondary analysis of the OMEMI trial
  • Author: Myhre, Peder L ; Kalstad, Are A ; Tveit, Sjur H ; Laake, Kristian ; Schmidt, Erik B ; Smith, Pal ; Nilsen, Dennis W T ; Tveit, Arnljot ; Solheim, Svein ; Arnesen, Harald ; Seljeflot, Ingebjørg
  • Subjects: Aged ; Atrial Fibrillation - drug therapy ; Dietary Supplements ; Docosahexaenoic Acids ; Eicosapentaenoic Acid - pharmacology ; Eicosapentaenoic Acid - therapeutic use ; Fatty Acids, Omega-3 - therapeutic use ; Humans ; Myocardial Infarction - epidemiology
  • Is Part Of: Journal of internal medicine, 2022-05, Vol.291 (5), p.637
  • Description: The cardiovascular benefit from n-3 polyunsaturated fatty acids (PUFAs) after acute myocardial infarction (AMI) is controversial, and the importance of serum eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) concentrations for clinical events is unclear. To assess changes in EPA and DHA serum concentrations during n-3 PUFA supplementation and their association with incident cardiovascular events. In the OMEMI trial, elderly patients with a recent AMI were randomized to 1.8 g/day of EPA/DHA or control (corn oil) for 2 years. The primary outcome was a composite of AMI, coronary revascularization, stroke, heart failure hospitalization, or all-cause death (major adverse cardiovascular event [MACE]) and the secondary outcome was new-onset atrial fibrillation (AF). EPA and DHA measurements were available in 881 (92% of survivors) participants at randomization and study completion. EPA and DHA increased in the active treatment arm (n = 438) by a median of 87% and 16%, respectively. Greater on-treatment increases in EPA and DHA were associated with decreasing triglycerides, increasing high-density lipoprotein cholesterol, and lower baseline EPA and DHA concentrations. Greater on-treatment increases in EPA were associated with lower risk of MACE (adjusted hazard ratio 0.86 [95% confidence interval, CI, 0.75-0.99], p = 0.034), and higher risk of AF (adjusted hazard ratio (HR) 1.36 [95% CI 1.07-1.72], p = 0.011). Although there were similar tendencies for DHA changes and outcomes, these associations were not statistically significant (HR 0.84 [0.66-1.06] for MACE and 1.39 [0.90-2.13] for AF). Greater on-treatment increases in EPA were associated with lower risk of MACE and higher risk of new-onset AF. These data suggest that the cardiovascular effects of increasing n-3 PUFA levels through supplements are complex, involving both potential benefits and harm.
  • Publisher: England: Blackwell Science Ltd
  • Language: English;Norwegian
  • Identifier: ISSN: 0954-6820
    EISSN: 1365-2796
    DOI: 10.1111/joim.13442
    PMID: 34982486
  • Source: NORA Norwegian Open Research Archives
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